Labor market work and home care's unpaid caregivers

People who provide intensive and time-consuming care to others at home - such as assisting with feeding, bathing and toileting - are the caregivers who are most vulnerable to dropping out of the labor force, according to a new systematic review of studies on unpaid caregivers.

The workforce participation of caregivers who provide occasional assistance is very different from those who spend many hours tending a family member or loved one, according to lead review author Meredith Lilly.

“People who drive someone to a doctor's appointment or make meals once or twice a week — those people really seem to be managing it all,” Lilly said. “The people that can't are those who are providing very intensive care. They are a subset of caregivers who often live with the care recipient, and I would argue that they are the group we need to be worried about.”

Decision makers who are creating health and workplace policies should consider that distinction, said Lilly, a researcher in the Department of Health Policy, Management and Evaluation at the University of Toronto.

The review analyzed 35 studies of unpaid caregivers and found that they are as likely as other people are to hold paid jobs outside the home. However, unpaid caregivers are more likely to make subtle workplace changes such as working from home or reducing work hours.

Lilly and her team argue that the outside employment of unpaid caregivers is critical to an individual's financial security and a nation's economy.

The review appears in the December 2007 issue of The Milbank Quarterly.

A caregiver who withdraws from the labor market could be putting his or her lifetime earning potential and retirement-savings opportunities at risk, while employers might be losing valuable workers.

“Health care decision makers are looking at unpaid caregivers as a vast source of free labor that may ease the health care crisis. I think that perspective on solving the health system financing crunch is shortsighted,” Lilly said.

The approach could jeopardize the broader economy and individual caregivers, she added.

“A nation's productivity and tax base to pay for social services is based on the number of workers who are available in the labor force,” she said.

Existing policies like the U.S. Family and Medical Leave Act protect people who need to leave their job temporarily.

“If you aren't leaving, you aren't eligible,” Lilly said. “So the people who are reducing their time a little bit or juggling their schedules — they are left high and dry.”

Lilly says caregivers should receive help to balance that juggling act while they stay on the job.

“North American employers are terrified they will not have workers in the coming generations, so providing supports that keep people employed makes sense. It's the direction that the UK and Europe are going,” Lilly said. “In the UK, parents of young children have the legal right to work flexible hours, and the country is considering similar measures for caregivers.”

Work and health researcher Pat Armstrong says there is little information about the full cost of unpaid caregiving. Armstrong is a professor of sociology and women's studies at York University in Toronto.

“Spending 10 hours providing care at home then going to work makes for a very long workday; it's associated with higher rates of accidents and lower productivity. For caregivers, we don't have very good data, in terms of those who stay in the labor force, their health and what kind of work do they do while they are there,” she said.

A true calculation of the cost of unpaid care giving has to weigh more than wages and pensions, she said.

“Somebody pays. We are starting to see that it's a shared cost. In the question of payment, we need to include more than money, things like health. Ten years from now, what does that mean on the collective burden that society will have to bear? Someone's got to pay for the care for the caregiver,” Armstrong said.

The Milbank Quarterly : Heidi Bresnahan, publications manager, at (212) 355-8400.

Lilly MB, Laporte A, Coyte PC. Labor market work and home care's unpaid caregivers: a systematic review of labor force participation rates, predictors of labor market withdrawal, and hours of work. The Milbank Quarterly 85(4) 641-90, 2007.